超声造影对诊断早期肝硬化合并小肝癌的价值

目的：了解超声造影对肝硬化合并小肝癌的诊断价值。方法选取2010年5月至2013年6月收治的患者96例,进行超声造影检查,从而评价小肝癌的增强变化,并与动态增强 MRI 以及动态增强CT 进行对比。结果超声造影下的小肝癌表现出动脉期增强,静脉期降低,以增强期或者低增强为标准,最终诊断的正确率为85．4％（82/96）,进一步结合延迟期肝癌的低增强的指标,诊断的正确率达到94．8％（91/96）,假阳性率为5．2％（5/96）。结论超声造影在诊断早期肝硬化合并小肝癌方面有着较为理想的价值。     

超声造影在肝硬化再生结节与肝细胞性肝癌鉴别诊断中的应用

目的探讨超声造影（CEUS）在肝细胞性肝癌（HCC）与肝硬化再生结节诊断和鉴别诊断中的应用价值。方法对46例肝硬化背景的58个局灶性病变进行超声造影检查并观察其动脉相、门脉相和实质相的动态造影变化,对不同性质病变的造影特点进行分析总结,并与穿刺病理诊断结果进行比较。结果肝细胞性肝癌患者中92.86%（13/14）的病灶具有造影剂的快进快出及85.71%（12/14）的病灶具有动脉相均匀性或非均匀性充填整个肿块的特点,超声造影剂在肝细胞性肝癌中的快进快出即动脉相快速增强,门脉相和实质相快速消退。结论超声造影在肝硬化与肝细胞性肝癌肝脏内局灶性异常回声的检查及鉴别诊断中具有重要的临床意义和应用价值。     

超声造影在肝硬化背景下对小肝癌诊断价值的Meta分析

目的 评价超声造影在肝硬化背景下对小肝癌的诊断价值. 方法 计算机检索1995至2012年4月Medline、PubMed、FMJS、中国知网、维普数据、万方数据及中国生物医学文献数据库,收集有关超声造影在肝硬化背景下诊断小肝癌的文献.由两位研究者根据纳入与排除标准独立筛选文献、提取资料,采用诊断精确性研究的质量鉴定法进行质量评价以及Meta-Disc 1.4软件进行Meta分析.对数据进行Spearman相关分析、x2检验、Cochran Q检验.结果 共纳入符合标准的6篇文献(380个病灶),根据研究中造影剂不同分为Levovist组和Sonovue组分别进行Meta分析.Sonovue组和Levovist组在肝硬化背景下对小肝癌的诊断,其合并灵敏度、特异度、阳性似然比、阴性似然比、诊断比值比分别为0.73[95％可信区间(CI)为0.67 ～ 0.79]和0.76(95％ CI为0.60 ～0.89)、0.89(95％ CI为0.81 ～ 0.94)和0.79(95％ CI为0.61 ～ 0.91)、6.53(95％ CI为2.74 ～ 15.52)和3.60(95％CI为1.89 ～ 6.85)、0.26(95％CI为0.13 ～ 0.54)和0.21 (95％CI为0.02 ～ 2.63)、27.50 (95％CI为7.99 ～ 94.72)和25.74 (95％CI为5.30 ～ 125.04).Sonovue组综合受试者工作特征曲线下面积=0.9252 (Q*=0.8595).结论 超声造影对肝硬化背景下的小肝癌有较高的诊断价值.     

超声造影对肝硬化小结节的诊断价值探讨

目的 探讨超声造影对肝硬化小结节的诊断价值。方法 2012年2月~2016年2月我院收治的130例肝硬化患者,分别进行增强CT扫描和超声造影检查。结果 在130例肝硬化患者肝内169个小结节中,经手术或肝活检组织病理学检查确诊为肝癌92例（70.8%）,包括115个病灶;增强CT扫描发现符合肝癌表现者62例,其Kappa值为0.250,诊断的准确率为65.4%（85/130）,敏感性为67.4%（62/92）,特异性为60.5%（23/38）;超声造影发现符合肝癌表现者87例,其Kappa值为0.871,诊断准确率为94.6%（123/130）,敏感性为94.6%（87/92）,特异性为94.7%（36/38）,两者相比,差异显著（P<0.05）;增强CT扫描和超声造影诊断的AUC分别为0.630和0.935,后者明显大于前者（P<0.05）。结论 超声造影能显著提高对肝硬化小结节的定性诊断,值得临床进一步研究。     

超声造影灌注时相分析在肝硬化背景下对肝脏增生结节的诊断价值

目的 探讨超声造影(CEUS)灌注时相分析在肝硬化背景下对肝脏增生结节的诊断价值.方法 2017年6月～2020年6月我院诊治的肝硬化患者100例,均接受CEUS检查,获得超声造影定量参数,包括造影峰值强度(Peak)、达峰时间(TTP)和平均度越时间(MTT),记录两组局部血容量(RBV)和局部血流量(RBF)水平....     

多模态影像定量参数在肝硬化背景下小肝癌及增生结节的鉴别诊断价值

目的 探讨多模态影像定量参数在肝硬化背景下小肝癌(SHCC)及增生结节的鉴别诊断价值.方法 80例肝硬化合并病灶性占位患者,根据病理诊断分为肝硬化小肝癌46例(SHCC组)与肝硬化增生结节组34例(结节组),对SHCC组及结节组进行术前CT、超声造影(CEUS)及MRI检查,观察两类病灶影像特征,并行定量参数对比研究....     

超声造影与增强CT检查诊断原发性肝癌的价值比较研究

目的 比较超声造影与增强电子计算机断层扫描(CT)检查诊断原发性肝癌（PLC）患者的价值。方法 2013年2月～2016年2月我院收治的PLC患者110例,所有患者均行超声造影、增强CT和数字减影血管造影（DSA）检查。以DSA检查结果为金标准,比较超声造影与增强CT检查的影像学表现,并评价两者的诊断效能。结果 超声造影和增强CT发现动脉期高增强、等增强和低增强分别为【103例（93.6%）、7例（6.4%）、0例（0.0%）和86例（78.2%）、24例（21.8%）、0例（0.0%）,P＜0.01】;门脉期呈高增强、等增强、低增强分别为【0例（0.0%）、16例（14.5）、94例（85.5）和0例（0.0%）、27例（24.5）、83例（75.5）,P＞0.05】;延迟期呈高增强、等增强、低增强分别为【0例（0.0%）、4例（3.6）、106例（96.4）和0例（0.0%）、15例（13.6）、95例（86.4）,P＜0.01】;超声造影诊断的灵敏性（97.3%）显著高于增强CT（75.5%,P＜0.01）,特异性为91.8%,显著高于增强CT的52.7%（P＜0.01）,准确性为95.5%,也显著高于增强CT的67.3%（P＜0.01）。结论 与增强CT比,超声造影诊断PLC具有更高的敏感性、特异性和准确性,对于原发性肝癌的临床影像学诊断可能具有更高的应用价值。     

实时超声造影和融合影像导航下微波消融与手术治疗小肝癌患者疗效比较*

目的 研究实时超声造影和融合影像导航技术下微波消融与手术治疗小肝癌患者的疗效。方法 2013年12月～2016年12月我院收治的142例原发性肝癌患者被随机分为两组,每组71例。对观察组患者实施实时超声造影和融合影像导航下微波消融治疗,给予对照组实施外科手术切除治疗。采用酶速率法测定血清α-L-岩藻糖苷酶(AFU)水平,采用ELISA法测定血清甲胎蛋白(AFP)水平,采用免疫放射法测定血清糖类抗原19-9(CA19-9)水平。结果 在术后3个月,观察组肿瘤完全消融率为93.8%,对照组完全切除率达100.0%(P>0.05);两组血清AFP、AFU和CA19-9水平比较差异无统计学意义(P＞0.05);术后,观察组肺部感染、胆漏、皮肤切口感染、腹腔或胸腔积液等并发症发生率为4.2%,显著低于对照组的25.3%(P＜0.05);随访3～36个月(中位随访18个月),观察组累积生存率为73.2%(52/71),对照组为71.8%(51/71),两组差异无统计学意义(Log-rank值=0.086,P=0.763)。结论 在实时超声造影联合融合影像导航技术支持下行微波消融治疗小肝癌患者,疗效与手术切除相当,但并发症更少,值得临床积极开展和验证。     

超声造影对老年肝硬化背景下肝局灶性小病变的诊断价值

目的探讨超声造影对肝硬化合并肝内局灶性小病灶(≤3.0 cm)的诊断价值。方法回顾性分析该院2011年11月至2012年11月间收治入院的30例合并39个肝内局灶性小病灶(≤3.0 cm)肝硬化患者的常规超声和超声造影检查资料。将常规超声和超声造影结果与病理学结果进行对照分析,计算常规超声和超声造影的敏感性、特异性及准确性。结果本研究30例合并39个肝内局灶性小病灶(≤3.0 cm)肝硬化患者均经超声引导下经皮肝穿刺或外科手术后组织学活检确诊,其中良性病变16个(肝海绵状血管瘤8个病灶,肝囊肿3个病灶,肝硬化结节2个病灶,炎性病变2个病灶,局限性脂肪浸润1个病灶),恶性病变23个(原发性肝细胞癌17个病灶,肝脏转移瘤6个病灶)。超声造影敏感性、特异性、阴性预测率分别为91.67%、93.33%、87.50%,常规造影检查敏感性、特异性、阴性预测率分别为77.78%、83.33%、62.50%,超声造影检查结果均明显优于常规超声检查。结论超声造影技术对鉴别肝硬化合并肝内局灶性小病灶(≤3.0 cm)较常规超声具有更好的临床应用价值。     

超声造影鉴别肝硬化增生结节与肝细胞癌的价值探讨

目的：探讨超声造影在肝硬化增生结节和肝细胞癌（HCC）鉴别诊断中的应用价值。方法采用Sono Vue实时灰阶超声造影检查27个HCC和30个肝硬化增生结节,造影时记录并观察其动脉相、门脉相和实质相的动态造影变化及时间-强度曲线（TIC）的变化。结果 HCC病灶在CEUS的增强模式主要表现为快进快出（81.5%,22/27）和快进慢出（18.5%,5/27）,DN则呈多样化表现;HCC组超声造影后开始增强时间（11.48＆#177;2.87）s、增强达峰时间（23.27＆#177;7.75）s及峰值强度（PI）减半时间（84.85＆#177;21.93）s显著快于DN组（15.62＆#177;3.43）s、（37.89＆#177;14.99）s和（114.32＆#177;37.75）s,（P＆lt;0.05）,HCC组超声造影后PI（36.07＆#177;9.65）显著高于DN组（26.44＆#177;6.58）,（P＆lt;0.05）。结论 CEUS在HCC与DN的鉴别诊断中具有重要的临床应用价值。     

Diagnosis of small hepatic nodules detected by surveillance ultrasound in patients with cirrhosis: Comparison between contrast-enhanced ultrasound and contrast-enhanced helical computed tomography.

Aim: To investigate the diagnostic value for the diagnosis of small (1-2 cm) hepatic nodules detected by surveillance ultrasound in patients with cirrhosis using contrast-enhanced ultrasound (CEUS) compared with that of contrast-enhanced helical computed tomography (CECT). Methods: Seventy-two liver cirrhosis patients with 103 small hepatic nodules (1-2 cm) detected by surveillance ultrasound were enrolled in the present study. All patients underwent CEUS with SonoVue as well as CECT. Nodules which appeared by contrast enhancement during the arterial phase and contrast wash-out during the late phase on CEUS or CECT were diagnosed as malignant (hepatocellular carcinoma [HCC]). Histopathology obtained from biopsy or surgery served as the gold standard. Results: According to the above diagnostic criteria, the sensitivity (i.e. rate of correct diagnosis of HCC) was 91.1% (51/56 HCC) for CEUS and the specificity (i.e. the rate of correct exclusion of HCC) was 87.2% (41/47 regenerative nodules [RN]).Therefore, the diagnostic accuracy of CEUS was 89.3% (92/103 all nodules). Using the same diagnostic criteria, the sensitivity, specificity and accuracy of CECT were 80.4% (45/56 HCC), 97.9% (46/47 RN), and 88.4% (91/103 all nodules). Overall, there was no significant difference between CEUS and CECT in the diagnostic confidence of small hepatic nodules. Eighty-six nodules (45 HCC and 41 RN) were correctly diagnosed by both modalities and six (five HCC and one RN) were misdiagnosed by both. Conclusion: The ability of CEUS in the characterization of small nodules (1-2 cm) detected by surveillance US in patients with liver cirrhosis is similar to that of CECT.     

Laparoscopic prediction of hepatocellular carcinoma in cirrhosis patients

Previously, laparoscopic studies have not been successful in predicting the occurrence of small hepatocellular carcinoma because cirrhotic patients had not been separated into groups of those who developed small hepatocellular carcinoma under 3 cm in diameter, and those who did not. Retrospective examination with better separation of the two groups gave improved results. Of the 26 laparoscopic findings, only the presence of large complex regenerative nodules was closely associated with the occurrence of subclinical small hepatocellular carcinoma. The study of other cirrhotic patients with and without large complex regenerative nodules gave a cumulative hepatocellular carcinoma occurrence rate of 73% for patients who had these nodules by the third year after laparoscopy. In contrast, the rate for patients without such nodules was 6%, showing a significant difference (P < 0.05) between the two groups. We concluded that the laparoscopic finding of large complex regenerative nodules of liver cirrhosis can be used to predict the occurrence, or a complication, of subclinical small hepatocellular carcinoma.     

肝癌、肝硬化患者淋巴细胞染色体着丝粒点结构的变化

目的 探讨染色体着丝粒点结构（Ｃｄ）的变化在肝癌发生过程的意义。方法 采用染色体Ｃｄ带技术检测２８例肝癌、２５例肝硬化及２６例正常人染色体Ｃｄ结构丢 失频率。结果 肝癌组Ｃｄ结构在总消失率、Ａ和Ｃ组染色体中明显高于肝硬化和正常对组（Ｐ〈０．０１）,在Ｄ、Ｅ组染色体中亦高于正常组（Ｐ〈０．０５）。结论 肝癌患者外周血细胞染色体Ｃｄ结构丢失在增高趋势,提示Ｃｄ结构消失率增加是引起肝癌细胞染色体非整倍性     

Juvenile hepatocellular carcinoma with congestive liver cirrhosis

A case of juvenile hepatocellular carcinoma (HCC) with congestive liver cirrhosis is reported. The patient was a 21-year-old woman. She had been diagnosed as having transposition of the great arteries, type 2, in 1978. She underwent the Mustard operation, but suffered from chronic heart failure. In 1995, she experienced abdominal pain and underwent examination. The laboratory data were normal, except for elevated total bilirubin (5.2mg/dl). Blood examinations were performed at frequent intervals, and the total bilirubin level fluctuated between 0.9 and 8.1mg/dl over the next 4 years, but the transaminase level remained normal. In 1999, she experienced abdominal pain again and was admitted to our hospital. Computed tomography showed four space-occupying lesions in the liver; 45mm, 20mm, 12mm, and 10mm in size. She was diagnosed as having HCC, and transcatheter arterial chemoembolization and percutaneous ethanol injection therapy were performed. Histology of the cancerous and the noncancerous liver tissue revealed HCC, moderately differentiated type, in cirrhotic liver with congestion. This patient had no background factors of liver disease, except for liver congestion, associated with the chronic heart failure. Because most patients with cardiac cirrhosis die of cardiac disease, only a small number of these patients develop liver failure. However, the incidence of HCC in patients with congestive liver disease is likely to increase in the future, as survival time is prolonged with the advances in treatment for chronic heart failure. Therefore, patients with congestive liver disease should be followed, taking into account the possibility of HCC.     

Hand-assisted laparoscopic left lateral segmentectomy of the liver for hepatocellular carcinoma with cirrhosis

Background/Purpose. Despite recent progress in trials with laparoscopic hepatectomy, it is still necessary to develop safe and stable techniques. We have performed laparoscopic hepatic resection for 30 patients with liver tumors to date. We have recently been applying a hand-assisted laparoscopic surgical technique for greater safety. Methods. In the present study, we report techniques using a hand-assisted laparoscopic anatomical left-lateral segmentectomy for hepatocellular carcinoma with liver cirrhosis. Results. Direct feeling with the surgeon’s hand makes possible a procedure that is almost identical to open surgery in which there is better visualization of the surgical field and transected margin, and immediate hemostasis is also achieved by manually depressing the bleeding point. Conclusions. With this method, laparoscopic anatomical hepatectomy can be performed more safely for patients with cirrhosis than by the fully laparoscopic method, although a larger incision is necessary.     

Ultrasound features of hepatocellular adenoma and the additional value of contrast-enhanced ultrasound

BACKGROUND: Hepatocellular adenoma(HCA) is a rare benign tumor of the liver. It is of clinical importance to differentiate HCA from other liver tumors, especially hepatocellular carcinoma(HCC). This study aimed to evaluate the characteristic features of HCA by conventional ultrasound and contrast-enhanced ultrasound(CEUS) findings.METHODS: Twenty-six patients(10 males and 16 females; mean age 36.2±5.0 years) with 26 histopathologically proven HCAs were retrospectively identified. According to the maximum diameter of HCAs, they were divided into three groups: 30 mm, 30-50 mm, and 50 mm. Ultrasound examinations were performed with C5-2 broadband curved transducer of Philips i U22 unit(Philips Bothell, WA, USA). For each lesion, a dose of 2.4 m L Sono Vue#174;(Bracco Imaging Spa, Milan, Italy) was injected as a quick bolus into the cubital vein. Lesions' echogenicity, color-Doppler flow imaging and contrast enhancement patterns were recorded.RESULTS: Grayscale ultrasound revealed that most of HCAs were hypoechoic(73.1%, 19/26). Spotty calcifications were detected in 26.9%(7/26) of the lesions. Color-Doppler flow imaging detected centripetal bulky color flow in 46.2%(12/26) of the HCAs. CEUS showed that 73.1%(19/26) of the HCAs displayed as rapid, complete and homogenous enhancement, and 53.8%(14/26) showed decreased contrast enhancement in the late phase. There was no significant difference in enhancement patterns among different sizes of HCAs(P0.05). Centripetal enhancement with subcapsular tortuous arteries was common in larger HCAs.CONCLUSIONS: CEUS combined with grayscale and colorDoppler flow imaging helped to improve preoperative diagnosis of HCAs. The characteristic imaging features of HCAs included: rapid homogeneous enhancement and slow washout pattern on CEUS; heterogeneous echogenicity on grayscale ultrasound; and centripetal enhancement with subcapsular tortuous arteries in large HCAs.     

The value of contrast-enhanced ultrasound in predicting postoperative recurrence of hepatocellular carcinoma: A protocol for systematic review and meta-analysis

Background:As one of the key factors, postoperative recurrence of hepatocellular carcinoma (HCC) influences the therapeutic effects and survival period of patients. Therefore, the early diagnosis of postoperative recurrence of HCC plays an important role in improving the therapeutic effects and prognosis. Contrast-enhanced ultrasound (CEUS) plays an important role in the early diagnosis of postoperative recurrence of HCC. However, the accuracy of CEUS in predicting postoperative recurrence of HCC is still controversial. Therefore, in this study, a meta-analysis was carried out to further evaluate the accuracy of CEUS in predicting postoperative recurrence of HCC, thus providing evidence support for the early diagnosis of HCC.Methods:The literatures on the CEUS diagnosis of postoperative recurrence of HCC were collected by searching China National Knowledge Infrastructure, Wanfang, China Biology Medicine disc, PubMed, EMBASE, Cochrane Library, and Web of Science on computer. The retrieval time is set from the start of the database until April 2021. The meta-analysis of the literatures that meet the quality standards was conducted by Stata 16.0 software.Results:The results of this meta-analysis will be submitted to a peer-reviewed journal for publication.Conclusion:This study will provide evidence support for the accuracy of CEUS in the diagnosis of postoperative recurrence of HCC.Ethics and dissemination:The private information from individuals will not be published. This systematic review also should not damage participants’ rights. Ethical approval is not available. The results may be published in a peer-reviewed journal or disseminated in relevant conferences.OSF Registration Number:DOI 10.17605/OSF.IO/HB46W.     

Guidelines for imaging focal lesions in liver cirrhosis

Imaging cirrhotic patients for early detection of hepatocellular carcinoma remains a challenging issue despite many technological advances. In fact, nonmalignant hepatocellular lesions, such as regenerative or dysplastic nodules, may mimic a small tumor. Imaging protocols are aimed at showing the different vascular supply to the lesion. It is accepted that dynamic contrast-enhanced imaging techniques, including contrast ultrasound, multidetector computed tomography and magnetic resonance imaging, can establish the diagnosis of hepatocellular carcinoma in nodular lesions larger than 1 cm showing arterial hypervascularization with venous washout. Magnetic resonance imaging in combination with liver-specific contrast agents, including hepatocyte-targeted and reticuloendothelial system-targeted agents, may be useful to clarify questionable cases, due to its ability to show changes in hepatobiliary function or Kuppfer cell content associated with malignancy. However, even optimized imaging techniques remain relatively insensitive for the detection of tiny satellite nodules associated with the main tumor.